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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192006321
Report Date: 10/13/2021
Date Signed: 10/13/2021 10:38:53 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MAOF CHILD CARE CENTER PRESCHOOLFACILITY NUMBER:
192006321
ADMINISTRATOR:MARIA PACHECOFACILITY TYPE:
850
ADDRESS:12440 FIRESTONE BOULEVARDTELEPHONE:
(562) 484-9700
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:75CENSUS: 10DATE:
10/13/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Maria Pacheco, DirectorTIME COMPLETED:
11:00 AM
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An unannounced Case Management Inspection was conducted on this day by Licensing Program Analyst (LPA) A. Lucero to follow up on an Unusual Incident Report that was received in the licensing office on 09/29/2021. LPA met with Director Maria Pacheco.

Interviews were conducted with child #1 regarding the incident. LPA obtained a copy of Response Notice provided to facility dated 9/28/21.

Based on all information obtained on this date, and interview conducted, follow-up may or may not be necessary regarding the incident.



The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Exit interview was conducted with Maria Pacheco, Appeal Rights given.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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